Exam 2: Vestibular Evaluation Flashcards
Seven important things to ask about when reveiwing past history:
- ● PMH
- ● ONSET OF SYMPTOMS
- ● TIMING
- ● RISK FACTORS
- ● EXPOSURE TO OTOTOXINS
- ● MEDS
- ● VESTIBULAR ENG RESULTS
Good questions about symptoms (3-9)
- ● DESCRIPTION OF SYMPTOMS
- ● DURATION
- ● SPELLS
- GRADUAL ONSET
- MOTION PROVOKED
- CONTINUOUS
- SPONTANEOUS
- POSITIONAL
- TIME OF DAY
Work Up for Vertigo (tons of stuff)
History
- Vertigo (what does the patient mean by dizziness?)
- Onset
- Intensity
- Duration
- Association with nausea and vomiting
- Feeling of faintness or loss of consciousness
- Hearing loss
- Tinnitus
- Feeling of fullness in ear
- History of ear pain, infection, surgery
- Recent illness
- Current medications
- Previous neurologic disorders (transient ischemic attack, stroke, multiple sclerosis, migraine headache)
More questions about to consider in Evaluaton History
- ● NEW GLASSES
- ● HEARING PROBLEMS
- ● COGNITIVE SYMPTONS
- ● SEVERITY ON A SCALE
- ● SYMPTOMS ACCOMPANIED BY
- ● TINNITUS
- ● AURAL FULLNESS
- ● VOMITING, NAUSEA
- ● OSCILLOPSIA
*
Other things to evaluate besides directly vertigo-related stuff:
Normal Stuff:
- ● RANGE OF MOTION
- ● STRENGTH
- ● MUSCLE TONE
- ● SENSATION
- ● PAIN
- ● NON EQUILIBRIUM COORDINATION TESTS
- ● BP IN SITTING AND STANDING
She also said Spontanious Nystagmus on this slide (suggests CNS problem)
seven Visual Vestibular Interaction Tests
- Saccades
- Smooth Persuit
- VOR
- VORc in Phase
- VORc Out of Phase
- Dynamic Visual Acuity
- Head Thrust Test
What are the three test of VOR?
- VOR
- Dynamic Visual Acuity test
- Head Thrust test
Describe the Dynamic Visual Acuity test
● USING TEN FOOT SNELLEN CHART
- Read line with HEAD STATIONARY (which is lowest line?)
- Read line with HEAD MOVING (which is lowest line now?)
- Head SLOW SPEEDS OF TWO TO THREE HERTZ (use metronome!)
- LOSS OF GREATER THAN TWO TO THREE LINES IS INDICATIVE OF A PROBLEM WITH THE VOR
Describe the Head Thrust test
- ● RAPID PASSIVE HEAD MOVEMENT TO TEST PERIPHERAL VESTIBULAR FUNCTION
- ● PATIENTS WITH UVL MAKE ONE OR MORE COMPENSATORY SACCADES TO BRING THE EYES ON TARGET WHEN THE HEAD IS MOVED TO THE SIDE OF THE LESION
Like VOR test, but therapist moves pt head at random times.
- Pt tries to keep eyes on therapist nose
- Therapist rotates head to one side (faster speeds)
- Look for catch up saccade when testing toward the side of the lesion
- Saccade will be toward the intact side (trying to correct for the lack of VOR stimulation of the eyes to move opposite the direction of head movement.
What are some postural control tests?
- ● SITTING
- ● STANDING
- ● ALIGNMENT
- ● ACTIVE WEIGHT SHIFTS
- ● PASSIVE WEIGHT SHIFTS
- ● INDUCED WEIGHT SHIFTS
- ● PERCEIVED LIMITS OF STABILITY
- ● UNILATERAL STANCE
- ● TANDEM STANCE
Four Vestibulospinal Tests
● FUKUDA’S TEST
● ROMBERG TEST
● SHARPENED ROMBERG
● SLS (single leg stance)
What are some functional gait activities tests?
● FUKUDA’S MARCH
● WALK STOP ABRUPTLY
● WALK PIVOT SHARPLY
● WALK WITH HEAD MOTION
● TANDEM WALK
● ADJUST SPEED OF WALKING
● WALK ON HEELS
● WALK ON TOES
● WALK BACKWARD
What are some high level gait tests?
● ENDURANCE
● CURBS
● STAIRS
● BUSY VISUAL ENVIRONMENT
● TINETTI
● BERG BALANCE SCALE
● FUNCTIONAL REACH
How do we rule out VBI?
Nancy reccommeds sitting pt in chair, putting their head back, then rotating chair while keeping head still. If it reproduces symptoms, VBI is likely the cause (or at least involved)
What is Oscillopscia?
the jumbling or blurry vision when head is moving.
